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General NPI Number Information
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NPI Number | 1669847901
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Entity Type | Organization
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Legal Business Name | CRISTINA MANTILLA, LMHC, LLC
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Dates
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Enumeration Date | 12/12/2015
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Last Update Date | 12/12/2015
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Provider Practice Location Address
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Address Line | 5745 MAIN ST SUITE 202
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-2737
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Country | US
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Telephone | 727-505-6379
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Fax | 866-926-7270
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Provider Business Mailing Address
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Address Line | 5745 MAIN ST SUITE 202
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-2737
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Country | US
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Telephone | 727-505-6379
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Fax | 866-926-7270
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Authorized Official
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Title or Position | LMHC/OWNER
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Name | MS. CRISTINA MANTILLA
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Credential | LMHC
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Telephone | 727-505-6379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH10384
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License Number State | FL
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